| Irritable bowel syndrome is the most | | | | is established.More recently, food |
| common gastrointestinal diagnosis yet it | | | | intolerance other than gluten or wheat |
| is not really a disease nor does it have | | | | have been suggested as a treatable cause |
| confirmatory diagnostic tests. Rather, | | | | of IBS. Blood tests for a type of |
| it is diagnosed based on a constellation | | | | antibody known as IgG have been |
| of symptoms and the absence of other | | | | advocated by several researchers as |
| diagnoses. Common symptoms attributed to | | | | being helpful for advising people about |
| IBS are abdominal pain, cramping, | | | | eliminating or avoiding certain foods as |
| diarrhea, bloating and excess gas. | | | | a treatment of IBS. Recent evidence |
| Celiac disease or gluten sensitivity is | | | | suggests that a significant reduction of |
| a common but frequently missed | | | | IBS symptoms can be achieved in people |
| gastrointestinal diagnosis. Ingestion of | | | | who avoid foods based on elevated IgG |
| gluten containing foods in affected | | | | antibodies to foods. Atkinson et. al |
| individuals commonly causes symptoms | | | | 2004 reported 10-26% improvement in |
| attributed to IBS that are relieved with | | | | symptoms in patients compared with |
| gluten-free diet in at least 10-20% of | | | | controls. Deterioration was noted in |
| people misdiagnosed with IBS. Other food | | | | those who relaxed their dietary |
| intolerances are also a likely a cause | | | | restriction of foods they had avoided |
| of IBS symptoms that may improve with | | | | because of elevated antibody levels. |
| avoidance of certain foods.IBS is a | | | | These findings require further |
| diagnosis of exclusion. Other causes of | | | | validation and are facing significant |
| symptoms of abdominal pain, diarrhea, | | | | resistance to acceptance by many in the |
| constipation, or alternating | | | | medical community, especially in the |
| constipation and diarrhea should be | | | | U.S. However, elimination diets have |
| excluded by doctor's review of medical | | | | long been reported effective by many |
| history, a physical exam and some | | | | people. The possibility of food |
| screening laboratory tests and arguably | | | | intolerance as a reversible cause of |
| a colonoscopy. The other conditions that | | | | symptoms attributed to a syndrome with |
| traditionally doctors are most concerned | | | | little other effective treatments except |
| about excluding include inflammatory | | | | mostly ineffective treatments in the |
| bowel diseases (ulcerative colitis, | | | | past and very new medications with |
| Crohn's disease) and cancer. Less | | | | limited efficacy and unproven long term |
| worrisome but treatable conditions that | | | | safety should prompt further studies and |
| need to be excluded include lactose | | | | an openness to dietary trials.If you |
| intolerance, intestinal infections | | | | have been diagnosed with irritable bowel |
| especially parasites like giardia, and | | | | syndrome I recommend you confirm that |
| food intolerance. Celiac disease though | | | | Celiac disease has been excluded. Food |
| now known to be very common, affecting | | | | intolerance should also be considered |
| approximately one percent of the U.S. | | | | though testing may not be covered by |
| population, has been largely ignored as | | | | your insurance and/or accepted by your |
| a possible cause of IBS symptoms. Most | | | | doctor as valid. Elimination of common |
| primary care physicians are aware that | | | | foods and their proteins causing |
| diarrhea is a common symptom of Celiac | | | | intolerance, wheat, barley and rye |
| disease but not that it may present in | | | | (gluten); cow's milk protein (casein); |
| adults and be associated with | | | | soy; and peanuts is worth a try. Be sure |
| constipation. Most doctors are unaware | | | | to keep a food-symptom diary and |
| that the prevalence of Celiac disease in | | | | re-introduce one food or food protein |
| IBS patients may be as high as | | | | back into your diet at a time. One diet |
| 20%.Typical lab tests ordered by doctors | | | | that effectively eliminates all the |
| screening for more serious intestinal | | | | major food proteins causing intolerances |
| diseases that may mimick IBS include a | | | | but may be difficult to follow is the |
| complete blood count (CBC) looking for | | | | paleo diet ( Hoey. "Irritable Bowel |
| signs of blood loss or anemia (low | | | | Syndrome: Could it be Celiac Disease?" |
| hemoglobin or hematocrit), signs of | | | | Can Med J. 2002; 166:479-802. Sander et |
| inflammation or infection (high white | | | | al, "Association of Adult Coeliac |
| blood cell count and/or platelet count) | | | | Disease with Irritable Bowel Syndrome: A |
| and stool tests for blood (fecal occult | | | | Case-Control Study in Patients |
| blood test or FOBT) or white blood cells | | | | Fulfilling Rome II Criteria Referred to |
| (WBCs or fecal leukocytes). The stool | | | | Secondary Care." Lancet. 2001; |
| tests are looking for signs of bleeding, | | | | 358:1504-82. Atkinson W; Sheldon TA; |
| infection or inflammation of the | | | | Shaath N; Wharwell PJ. "Food elimination |
| intestine. IBS does not cause bleeding | | | | bsed on IgG antibodies in irritable |
| or intestinal inflammation whereas | | | | bowel syndrome; a randomised controlled |
| inflammatory bowel disease, infection or | | | | trial." Gut 2004; 53:1459-1464.3. |
| cancer may. Normal tests are reassurring | | | | Isolauri E; Rautava S; Kalliamaki M. |
| though do not exclude more serious | | | | "Food allergy in irritable bowel |
| disease. Most gastroenterologists | | | | syndrome: new facts and old fallacies." |
| believe a colonoscopy should be | | | | Gut 2004; 53:1391-3.Dr. Scot Lewey is a |
| performed.However, most doctors, even | | | | physician who is subspecialty trained |
| many gastroenterologists, fail to test | | | | and board certified in gastroenterology |
| for Celiac disease though it is common | | | | (diseases of the digestive tract) that |
| and screening blood tests exist. The | | | | has over 20 years of experience as an |
| reasons for this are many and are more | | | | expert clinician, researcher, lecturer |
| fully explained elsewhere. However, the | | | | and author of more than twenty articles, |
| common incidence, presence of screening | | | | book chapters, and scientific abstracts. |
| tests and available treatment should | | | | His special interests include Celiac |
| make screening for Celiac disease part | | | | disease, food intolerance and allergies, |
| of the standard evaluation of all | | | | colitis, Crohn's disease, irritable |
| patients presenting with symptoms | | | | bowel syndrome & reflux. |
| suggestive of IBS before that diagnosis | | | | |